Stents are often used in the gastrointestinal tract to treat malignant or benign strictures as palliative or supporting treatment to chemotherapy or surgery. With biliary stent applications, plastic stents are often used. Plastic stents are typically have an outer diameter of 3.5 mm and an inner diameter of 2.5 mm and need to be exchanged relatively often (e.g., every three months) due to occlusion from bile. However, an advantage of plastic stents, besides their lower cost, is that their relative small size enables their use within and endoscopy instrument or endoscope. Conversely, self expanding metal stents (SEMS), are also useable and tend to have a longer patency than plastic stents because of their larger diameters, typically 8-10 mm, and having a further advantage that metal stents are collapsible from a larger to smaller diameter and may fit within and endoscope, and then expanded to a larger diameter. However, plastic stents are removable, whereas, metal stents generally are not. Common practice calls for removing stents when treatment of benign strictures is completed.
Accordingly, metal stents are generally restricted to use where malignant, not benign, strictures are present. In addition to the problems of permanency of metal stents, their costs are 10 to 15 times higher than plastic stents.
Because of inherent material deficiencies, plastic stents cannot be made and reliably used, having larger diameters that collapse down to small diameters and retaining good compression resistance as with self expanding metal stents. A need had developed for a stent having inner and outer diameters in a range similar to metal stents, e.g., 8-10 mm, yet have a low entry profile, and also be removable. SMP stents satisfy this need with SMP stents both being useable at the relatively large diameters, thereby providing good patency, and being removable, thus allowing for use with both benign and malignant applications. Additionally, a major benefit of SMP stents is that they are collapsible to a small diameter for insertion into a lumen of a patient, but can then be expanded like a metal stent once inside a patients lumen and then have the functional characteristics of a plastic stent.
SMP stents are preferably formable as tubular structures (which may be etched) or as coiled structures resembling coil springs. With either configuration, a straight, generally cylindrical shape may not be desired, due to the possibility of migration within a bodily passageway. A method has been developed of pre-forming SMP stents with one or both ends flared, with the SMP stents recovering this configuration in vivo at the point of implantation. However, in preparing the SMP stents, the stents are initially pre-formed with the flared-end configuration and then contracted to a minimized diameter for insertion into a catheter (in being readied for implantation). The contracted profile of the SMP stents resembles proportionately the profile of the fully-expanded stents, with the ends being likewise flared. With the smallest possible profile being sought for insertion into a patient, the flared-end configurations of the contracted SMP stents may be undesirable. Another method of minimizing migration of an SNIP stent is to form the stent with the inclusion of a shaped or textured outer surface, which therefore provides mechanical connection between the stent and the luminal surface of the vessel where the stent is implanted.